1. Prognostic indicators for recurrent thrombotic events in HIV-infected patients with acute coronary syndromes: use of registry data from 12 sites in Europe, South Africa and the United States.
- Author
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D'Ascenzo F, Cerrato E, Appleton D, Moretti C, Calcagno A, Abouzaki N, Vetrovec G, Lhermusier T, Carrie D, Das Neves B, Escaned J, Cassese S, Kastrati A, Chinaglia A, Belli R, Capodanno D, Tamburino C, Santilli F, Parodi G, Vachiat A, Manga P, Vignali L, Mancone M, Sardella G, Fedele F, DiNicolantonio JJ, Omedè P, Bonora S, Gaita F, Abbate A, and Zoccai GB
- Subjects
- Acute Coronary Syndrome diagnosis, Acute Coronary Syndrome mortality, Acute Coronary Syndrome therapy, Adult, Aged, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Cause of Death, Europe, Female, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Myocardial Infarction etiology, Myocardial Infarction mortality, Percutaneous Coronary Intervention, Proportional Hazards Models, Recurrence, Registries, Retrospective Studies, Reverse Transcriptase Inhibitors therapeutic use, Risk Factors, South Africa, Thrombosis diagnosis, Thrombosis mortality, Thrombosis therapy, Time Factors, Treatment Outcome, United States, Acute Coronary Syndrome etiology, HIV Infections complications, Thrombosis etiology
- Abstract
Aims: Limited data are available on prognostic indicators for HIV patients presenting with ACS., Methods and Results: Data on consecutive patients with HIV infection receiving standard highly active antiretroviral therapy (HAART) presenting with ACS between January 2001 and September 2012 were collected. Cardiac death and myocardial infarction (MI) were the primary end-points. 10,050 patients with ACS were screened, and among them a total of 201 patients (179 [89%] males and a median age of 53 [47-62] years) were included, 48% of them admitted for ST-elevation myocardial infarction and 14% having left ventricular systolic dysfunction (LVSD) at discharge. CD4+ counts less than 200 cells/mm(3) were reported in 18 patients (9%), and 136 patients (67%) were treated with nucleoside-reverse transcriptase inhibitors (NRTI). After a median of 24 months (10-41), 30 patients (15%) died, 12 (6%) for cardiac reasons, 20 (10%) suffered a MI, 29 (15%) a subsequent revascularization, and 7 (3%) a stent thrombosis. Other than LVSD (hazard ratio=6.4 [95% confidence interval [CI]: 1.6-26: p=0.009]), the only other independent predictor of cardiac death was not being treated with NRTI (hazard ratio=9.9 [95% CI: 2.1-46: p=0.03); a CD4 cell count <200 cells/mm(3) was the only predictor of MI (hazard ratio=5.9 [95% CI: 1.4-25: p=0.016])., Conclusions: HIV patients presenting with ACS are at significantly increased risk for cardiac death if not treated with NRTI, and at significantly increased risk of MI if their CD4 cell count is <200 cells/mm(3), suggesting that the stage of HIV disease (and lack of NRTI treatment) may contribute to cardiovascular instability., (Copyright © 2014 Elsevier Ltd. All rights reserved.)
- Published
- 2014
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